Provider Demographics
NPI:1467025775
Name:HATCHETT, DEANNA (LPN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2055
Mailing Address - Country:US
Mailing Address - Phone:773-553-1000
Mailing Address - Fax:
Practice Address - Street 1:601 WILLOW ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1140
Practice Address - Country:US
Practice Address - Phone:815-806-4600
Practice Address - Fax:815-806-4601
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.114826164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1063541688Medicaid